They acknowledge “the salutary provisions included in the legislation, notably an expansion of Medicaid coverage, increased funds for community clinics, and regulations to curtail some of private insurers’ most egregious practices,” write Dr. Oliver Fein, Dr. David Himmelstein, and Dr. Steffie Woolhandler.

But these are outweighed, they say, by the bill’s killer flaws.

The individual mandate “would reinforce private insurers’ stranglehold on care” by forcing millions of people to buy insurance on the private market. “Those who dislike their current employer-sponsored coverage would be forced to keep it,” they write. “Those without insurance would be forced to pay private insurers’ inflated premiums, often for coverage so skimpy that serious illness would bankrupt them.”

The individual mandate, by the way, was the top priority of the private insurance lobby.

The leaders of the single-payer organization cite four other problems with the bill.

Three: “The bill would drain $43 billion from Medicare payments to safety-net hospitals, threatening the care of the 23 million who will remain uninsured even if the bill works as planned.”

And four: “The bill would leave hundreds of millions of Americans with inadequate insurance. . . . Predictably, as health care costs continue to grow, more families will face co-payments and deductibles so high that they preclude adequate access to care.”

This last point puts the lie to the claim that the bill will cover 26 million more Americans. Actually, it will force most of those 26 million either to buy private insurance or pay a fine of $750 a person or $2,250 a family by the year 2016. Millions of people will likely to choose to pay that fine rather than pay the premiums, co-pays, and deductibles that can reach four, five, or six times the fine.

It points out that the much-heralded prohibition on not covering people with preexisting conditions is far less than meets the eye.

For instance, “insurers can charge four times more based on age plus more for certain conditions, and continue to use marketing techniques to cherry-pick healthier, less costly enrollees. So the insurance companies might not have a policy of not covering preexisting conditions, but they would have a practice of doing it.

Also, check this out: “Insurers may continue to rescind policies for ‘fraud or intentional misrepresentation’—the main pretext insurance companies now use to cancel coverage,” notes the nurses’ union.

Much of the bill is a straight up handout to the private insurance companies.

Remember the Medicare buy in proposal for people between the ages of 55 and 65? Well, that’s gone from the bill, and in its place, the government will pay employers and the insurance companies for covering the part of this cohort that is retired. The program “will reimburse employers or insurers for 80 percent of retiree claims between $15,000 and $90,000,” the bill says, according to an excellent breakdown by the Kaiser Family Foundation.

Gone, too, of course, is any public option.

“Sadly, we have ended up with legislation that fails to meet the true test of health care reform, guaranteeing high quality, cost-effective care for all Americans,” said Karen Higgins, co-president of National Nurses United. Instead, she added, we are “further locking into place a system that entrenches the chokehold of the profit-making insurance giants on our health.”

By Wendell Berry

Manifesto: The Mad Farmer Liberation Front

Love the quick profit, the annual raise,
vacation with pay. Want more
of everything ready made. Be afraid
to know your neighbors and to die.
And you will have a window in your head.
Not even your future will be a mystery
any more. Your mind will be punched in a card
and shut away in a little drawer.
When they want you to buy something
they will call you. When they want you
to die for profit they will let you know.
So, friends, every day do something
that won’t compute. Love the Lord.
Love the world. Work for nothing.
Take all that you have and be poor.
Love someone who does not deserve it.
Denounce the government and embrace
the flag. Hope to live in that free
republic for which it stands.
Give your approval to all you cannot
understand. Praise ignorance, for what man
has not encountered he has not destroyed.
Ask the questions that have no answers.
Invest in the millennium. Plant sequoias.
Say that your main crop is the forest
that you did not plant,
that you will not live to harvest.
Say that the leaves are harvested
when they have rotted into the mold.
Call that profit. Prophesy such returns.
Put your faith in the two inches of humus
that will build under the trees
every thousand years.
Listen to carrion—put your ear
close, and hear the faint chattering
of the songs that are to come.
Expect the end of the world. Laugh.
Laughter is immeasurable. Be joyful
though you have considered all the facts.
So long as women do not go cheap
for power, please women more than men.
Ask yourself: Will this satisfy
a woman satisfied to bear a child?
Will this disturb the sleep
of a woman near to giving birth?
Go with your love to the fields.
Lie easy in the shade. Rest your head
in her lap. Swear allegiance
to what is nighest your thoughts.
As soon as the generals and the politicos
can predict the motions of your mind,
lose it. Leave it as a sign
to mark the false trail, the way
you didn’t go. Be like the fox
who makes more tracks than necessary,
some in the wrong direction.
Practice resurrection.

Wendell Berry is a poet, farmer, and environmentalist in Kentucky. This poem, first published in 1973, is reprinted by permission of the author and appears in his “New Collected Poems” (Counterpoint).